TOWN INFO z " la.
TowN OF LILLINGTON
1 p ZONING PERMIT
''in4:n«`' Planning & Inspections Department
106 West Front Street, Po Box 296 Langton NC 27546 • phone 910 -893 -2654 • fax 910 -893 -3693
Required Attachments: Submit a site plan showing the driveway, streets, parking, open space, sidewalk, utility lines,
major landscape features, and any existing and new structure(s) located in relation to the lot lines.
Name of Quick }} , SmpSOA Property E 2 . zap
Applicant 6 -i ( Owner
Home Sl3tJkJwStak Home Pp,Box `I9
Address Address
City /State iC x'1330 r`^
dt City /State A in %icnr AC afS
/Zip Sart /Zip
Telephone 1i9- 1 7y_(a1-7 Telephone to, 893 —S1li
Email ,bta tona4w• .wnt Email CCO Se_boUtnkyr. Cool
Property Address: What are you requesting to build Does propert access DOT road?
as Sax" S / what is the proposed use of the g
I-alb: (IC risti 6 property? Be specific. Number of dwellings / structures on
t t t _ 3 j the property already: 1
Parcel Identification Number(s): ne c � `�- Property / parcel size: j 1 2
O o �St� Erxls)M Lot number(s):
l C.s (ACE 03 E ms 6 (� 01 # a •
Owner / Applicant Must Read and Sign
AFFIDAVIT: The undersigned property owner, or duly authorized agent/representative thereof certifies that this application and the
foregoing answers, statements, and other information herewith submitted are in all respects true and correct to the best of their
knowledge and belief, WITH THE UNDERSTANDING THAT ANY INCORRECT INFORMATION SUBMITTED MAY RESULT
IN THE REVOCATION OF THIS APPLICATION. I hereby authorize the Town of Lillington to review this request and conduct a
site inspection to insure compliance to this application. I also understand that this Zoning Permits will expire six (6) months from the
date of issuance, if the permit is not acted upon.
Print Name Sig t"ure o fh wner ow • rr resentative Date
FOR OFFICE USE
Zoning District: Watershed District: Is property located in floodplain
C3 ❑ Not located in one • accordi g to the FEMA map?
_ J ❑ Cape Fear - Critical o ❑ Yes
Front Setback: 30 'I Cape Fear - Protected
Side Setback: Exempt from Watershed Regulations? 'ld °'
1 0 ❑ No, more than one acre of land Planner's Signature
Rear Setback: will be disturbed throughout entire ■. / ti.../ t t
a b 1 (including phases) project area. Date
I Yes, less than one acre
•
FAX TO FIRE MARSHAL'S OFFICE: (910) 893 -5025 & NCDOT (910) 437 -2529